Provider Demographics
NPI:1376657817
Name:PROGRESSIVE HEALTHCARE
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTHCARE
Other - Org Name:MONROE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DANSBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-322-7836
Mailing Address - Street 1:100 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-8537
Mailing Address - Country:US
Mailing Address - Phone:318-322-7836
Mailing Address - Fax:318-325-4438
Practice Address - Street 1:100 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8537
Practice Address - Country:US
Practice Address - Phone:318-322-7836
Practice Address - Fax:318-325-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD020461208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57592Medicare PIN